COLUMN-Ideology threatens to trump facts in official Medicare handbook

Reuters Staff

6 Min Read

(The writer is a Reuters columnist. The opinions expressed are his own.)

By Mark Miller

CHICAGO, May 24 (Reuters) - In September, the federal government will mail a handbook on Medicare enrollment to 43 million households. “Medicare & You” is an important, authoritative source on a wide array of plan options for the annual enrollment period that runs from Oct. 15 through Dec. 7, and it has been mailed out to beneficiaries each year since 1999.

But this year, advocate groups for seniors are crying foul over language contained in a draft of the 2019 handbook edition sent to them for review by the U.S. Centers for Medicare & Medicaid Services (CMS).

The Medicare Rights Center and two other groups (Justice in Aging and the Center for Medicare Advocacy) argue that the draft contains inaccurate, ideologically tinted descriptions of the tradeoffs between original fee-for-service insurance and a privatized managed-care alternative.

That is no small criticism - and it comes from authoritative organizations with deep expertise on Medicare policy, coverage and the laws governing the program. The choice between fee-for-service coverage and Medicare Advantage is the first that seniors make about their coverage - and one of the most important.

Moreover, the handbook problems fit a pattern in the Trump administration, which has taken a number of steps to impede the flow of unbiased health insurance assistance. The administration has twice proposed to eliminate federal funding for State Health Insurance Assistance Programs, which provide critical assistance to 3 million seniors annually with their plan selections (reut.rs/2s3cvQi), and it has slashed funding for consumer outreach and enrollment assistance for Affordable Care Act coverage.

CMS declined my request for an interview to discuss the criticisms. A CMS representative said feedback, along with consumer testing, is used to “inform the final product.” But the 2019 draft now under fire comes on the heels of similar criticisms leveled by advocates at the final 2018 handbook.

The key issue is whether CMS is steering enrollees to Medicare Advantage plans over original fee-for-service coverage.

Original Medicare - coupled with a stand-alone prescription drug plan and Medigap supplemental insurance - remains the gold standard for flexibility, since it can be used with any healthcare provider who accepts Medicare.

Medicare Advantage plans are managed-care networks, usually HMOs. They bundle together Part A (hospitalization), Part B (outpatient services) and often include Part D coverage (prescription drugs). Advantage plans also cap annual out-of-pocket expenses, so Medigap supplemental policies are not sold alongside the plans.

Advantage plans can save money for enrollees, and they are gaining in popularity. In 2017, some 19 million Medicare beneficiaries used Advantage plans - 33 percent of all enrollees, and up from just 5.6 million in 2005, according to the Kaiser Family Foundation. However, they come with important restrictions on available healthcare providers. Enrollees need to consider the tradeoffs carefully, using unbiased information.

TIPPING THE SCALES

The 2019 draft has not been made available to journalists, but the letter to CMS from advocacy groups raises objections to language found in several parts of the draft that they argue favors Advantage with incorrect wording, omissions or inaccuracies. In several spots, it describes Advantage as “the less expensive alternative for beneficiaries.” That is an overstatement, advocates say, since many variables determine whether Advantage will be more or less costly for any individual enrollee.

The letter also criticizes the draft for failing to make clear that Advantage plans limit access to providers. One recent study found shortcomings in the quality of providers in some Medicare Advantage provider networks. One out of every five plans did not include a regional academic medical center - institutions that usually offer the highest-quality care and specialists. Other research has raised questions about the quality of skilled nursing facilities (SNFs) that are included in Medicare Advantage provider networks. (reut.rs/2s3cvQi).

The most troubling criticism concerns a description of prior authorization requirements - the annoying procedure found in many health insurance plans that forces enrollees to run meaningless paperwork gauntlets before an insurer agrees to cover a specific procedure or service. The handbook actually describes the restriction as a benefit, rather than a mandatory hurdle for Advantage plan members that is not required in original Medicare.

“When you have a Republican administration, you expect them to adhere to Republican principles, and that includes favoring private insurance,” said Lindsey Copeland, director of federal policy for the Medicare Rights Center, one of the groups that penned the letter. (The others are Justice in Aging and the Center for Medicare Advocacy).

“We believe Medicare Advantage can be a great option for many people, and original Medicare is better for even more people - but we get concerned when CMS favors one over the other, or steers folks in one direction.”

There is still time for Medicare to correct the problems - and CMS should play this straight. Medicare Advantage is doing just fine without using the handbook to tip the scales. (Editing by Matthew Lewis)